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Review Article Olfactory Reference Syndrome British Journal of Pharmaceutical and Medical Research Vol.04, Issue 01, Pg.1617-1625, January-February 2019 Available Online at http://www.bjpmr.org BRITISH JOURNAL OF PHARMACEUTICAL AND MEDICAL RESEARCH Review ISSN:2456-9836 ICV: 60.37 Article Murat Eren Özen, Murat Aydin Olfactory Reference Syndrome: A Separate Disorder Or Part Of A Spectrum 1Psychiatrist, Department of Psychiatry, Private Adana Hospital, Adana Büyük şehir Belediyesi kar şısı, No:23, Seyhan-Adana- Türkiye. 2Private Dental Clinics, Gazipa şa bulv. Emre apt n:6 (kitapsan kar şısı) k:2 d:5 Adana- Türkiye. http://drmurataydin.com ARTICLE INFO ABSTRACT This article provides a narrative review of the literature on olfactory reference syndrome Article History: Received on (ORS) to address issues focusing on its clinical features. Similarities and/or differences with other psychiatric disorders such as obsessive-compulsive spectrum disorders, social anxiety 10 th Jan, 2019 Peer Reviewed disorder (including a cultural syndrome; taijin kyofusho), somatoform disorders and hypochondriasis, delusional disorder are discussed. ORS is related to a symptom of taijin on 24 th Jan, 2019 Revised kyofusho (e.g. jikoshu-kyofu variant of taijin kyofusho) Although recognition of this syndromes more than a century provide consistent descriptions of its clinical features, the on 17 th Feb, 2019 Published limited data on this topic make it difficult to form a specific diagnostic criteria. The core on 24 th Feb, symptom of the patients with ORS is preoccupation with the belief that one emits a foul or 2019 offensive body odor, which is not perceived by others. Studies on ORS reveal some limitations. Although there is a lack of data for validators, including symptom profile; familial aggregation; environmental risk factors; cognitive, emotional, temperament and personality Keywords: correlates; biological markers; patterns of comorbidity; course of illness: and response to Other Specified treatment, current data suggest that ORS appears different form other disorders, but, this Obsessive- Compulsive And difference is not enough to put this syndrome in a separate diagnosis., in DSM-5, ORS has its Related Disorder, place in the "Other Specified Obsessive- Compulsive or Related Disorder" category, in which, Obsessive- this category is for patients who have symptoms characteristic for obsessive-compulsive and Compulsive Spectrum Disorder, Imagined related disorder but do not meet the full criteria for any specific obsessive-compulsive or Body Odor related disorder. Further studies are needed for understanding the nature, prognosis, treatment and morbidity. Br J Phar Med Res Copyright©2019, Murat Eren Özen et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license. Corresponding Author: Murat Eren Özen, M.D., Psychiatrist, Department of Psychiatry, Private Adana Hospital, Adana Büyük şehir Belediyesi kar şısı, No:23, Seyhan -ADANA - Türkiye 1617 British Journal of Pharmaceutical and Medical Research Vol.04, Issue 01, Pg.1617-1625, January-February 2019 INTRODUCTION: Olfactory reference syndrome (ORS) is a ORS descriptions has been mentioned in previous condition in which individuals erroneously believe publications since the late 1800s (Potts CS, 1891) that they emit an unpleasant, foul, or offensive (Tilley H, 1895) (Bromberg W, 1934) (Harriman body odor. Odors may include almost anything PL, 1934)(Alvarez WC, 1959) (Philips KA, 2006) foul smelling and are often believed to originate (Philips KA, 2007). More than a hundred cases of from an organ or system, including the mouth, ORS have been reported. In the literature, cases genitals, rectum, or skin (APA, 2000). In clinical consistent with this syndrome appear between settings, common specific concerns include 1891 and 1966. Somehow, although the clinical halitosis, genital odor, sweat, flatulence or anal descriptions did not contain signs and symptoms odor (Philips KA et al., 2006). Uncommonly, sufficient to meet any of the psychiatric criteria, patients have concerns on emitting non-bodily reported cases with symptoms of ORS were odors such as ammonia (Tilley H, 1895), detergent described as schizophrenia. Pryse-Phillips, only in (Ross CA, 1987), burned rags (Harriman, 1934), 1971, defined the term olfactory reference or rotten onions (Sutton, 1919). Usually, the belief syndrome as a separate group with consistent of emitting an odor is often accompanied by ideas phenomenology, after characterizing a large case or delusions that the odor is noticeable to other series and carefully considering the differential people and they will react negatively, for example, diagnosis (Pryse-Philips W, 1971). As ORS by rubbing their nose in reference to the odor or involves a single delusional belief, it has also been turn away in disgust. Repetitive behaviors of referred to a type of monosymptomatic smelling themselves, showering excessively and hypochondriacal psychosis (Bishop ER, 1980) attempting to mask the odor are performed by (Beary MD, 1981) (Munro A, 1988) (Osman AA, many patients (Pyrse-Philips, 1971). 1991) (Ulzen TPM, 1993). History Fig.1: Olfactory reference syndrome has some specific symptoms for obsessive compulsive and related disorders but does not meet full criteria for any disorder in DSM-V ORS through DSM and ICD Classifications International Classification of Disease (ICD), the In both the Diagnostic and Statistical Manual of term ORS is not mentioned or included as a Mental Disorders, 4th. Edition (DSM-IV) and the separate disorder, However, ORS symptoms are 1618 British Journal of Pharmaceutical and Medical Research Vol.04, Issue 01, Pg.1617-1625, January-February 2019 considered as delusional disorder, somatic type in Clinical Features of ORS DSM IV (Potts CS, 1891); “Somatic delusions can Perceived Odors occur in several forms. Most common are the Unpleasant, foul or offensive body odors include person’s conviction that he or she emits a foul odor almost anything bad smelling and are often from the skin, mouth, rectum, or vagina….”(Potts believed to originate from an organ or the system CS, 1891). Similarly, ICD-10’s text on persistent (APA, 2000). Consistent with prior reports, ORS delusional disorders notes that delusions may patients most commonly focus on bodily smells, “express a conviction that…others think that he or such as general body odor, halitosis, genital odor she smells….”(Philips KA, 2007). In DSM-IV, and flatulence/fecal/anal odor. All subjects report ORS is also referred to as a type or part of social at least one odor that may normally be emitted anxiety disorder (social phobia), noting that from their bodies (Pryse-Philips W, 1971)(Iwu persons with social phobia may fear to offend with CO, 1990)(Osman AA, 1991)(Philips KA,2006) their body odor. Under the Cultural note for ORS (Begum M, 2010). Rarely, some patients reported in DSM-IV : “taijin kyofusho” . urine, sperm, sweat, armpit odor or malodorous “In certain cultures (e.g., Japan and Korea), from hands and feet (Tee CK, 2014)(Pryse-Philips individuals with Social Phobia may develop W, 1971)(Iwu CO, 1990)(Osman AA, 1991). persistent and excessive fears of giving offense to Occasional odors that patients reported are said to others in social situations…. These fears may take resemble non-bodily smells, such as ammonia, the form of extreme anxiety that blushing, eye-to- detergent, burned rags, candles or rotten onions eye contact, or one’s body odor will be offensive (Tilley H, 1895) (Sutton RL, 1919)(Harriman PL, to others. Taijin kyofusho , is similar to social 1934)(Ross CA,1987) (Begum M, 2010). Emitting phobia in Japan and Korea (Suzuki K, 2004). body odor that may smell like rotting fish is Although its clinical features are confusingly reported by the patients with an uncommon mentioned in three different sections of DSM-IV, metabolic disorder, which is also known as fish where they even are not adequately described, for malodor syndrome: trimethylaminuria (Mitchell more than a century, ORS has been stated as a SC, 2001). discrete syndrome in many cultures. However, Odor Hypersensitivity or Misinterpretation given the suffering and impairment associated Patients with temporal lobe epilepsy may have with it, the term ORS (currently the most widely complaints of smelling foul odors. Olfactory used term for this syndrome) is still not explicitly sensations caused by pituitary tumors may irritate mentioned.The questions whether ORS should be the hippocampus locally, so that foul odors mentioned as a part of other disorder such as “araise”. ORS symptoms differ from symptoms of delusional disorder or social phobia, or should be other disorders that may cause olfactory taken as a separate diagnosis with its own set of hallucinations, including migraine headaches, diagnostic criteria, remain unclear. head injury, intranasal disorders, consisting of a Statements on ORS through DSM and ICD typical bodily odor that emanates from the DSM-III-R: “Convictions that the person emits a sufferer; being persistent rather than brief and not foul odor…are one of the most common types of being accompanied by other auras, typical of delusional disorder, somatic type” (APA, 1987). temporal lobe epilepsy (APA-2014)
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